Healthcare Provider Details

I. General information

NPI: 1255667499
Provider Name (Legal Business Name): MELISSA SUE COLBATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA SUE GAYTON M.D.

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-5437
  • Fax: 254-724-2443
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN6228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: